Abstract

Background

The baseline to assess impact of a mass education-entertainment programme offered an opportunity to identify risk factors for domestic physical violence.

Methods

In 2002, cross-sectional household surveys in a stratified urban/rural last-stage random sample of enumeration areas, based on latest national census in Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe. Working door to door, interviewers contacted all adults aged 16–60 years present on the day of the visit, without sub-sampling. 20,639 adults were interviewed. The questionnaire in 29 languages measured domestic physical violence by the question "In the last year, have you and your partner had violent arguments where your partner beat, kicked or slapped you?" There was no measure of severity or frequency of physical violence.

Results

14% of men (weighted based on 1,294/8,113) and 18% of women (weighted based on 2,032/11,063) reported being a victim of partner physical violence in the last year. There was no convincing association with age, income, education, household size and remunerated occupation. Having multiple partners was strongly associated with partner physical violence. Other associations included the income gap within households, negative attitudes about sexuality (for example, men have the right to sex with their girlfriends if they buy them gifts) and negative attitudes about sexual violence (for example, forcing your partner to have sex is not rape). Particularly among men, experience of partner physical violence was associated with potentially dangerous attitudes to HIV infection.

Conclusion

Having multiple partners was the most consistent risk factor for domestic physical violence across all countries. This could be relevant to domestic violence prevention strategies.

Background

Domestic violence – also known as intimate partner abuse, family violence, wife beating, battering, marital abuse, and partner abuse – is an international problem[1, 2]. Domestic violence is not a single behaviour but a mix of assaulting and coercive physical, sexual, and psychological behaviours designed to manipulate and dominate the partner to achieve compliance and dependence. Women are more likely to experience physical injuries or psychological consequences[3, 4].

Domestic violence is well documented in several African countries. In eastern Nigeria, a clinic-based survey of 300 women reported 40% had experienced violence in the previous year[5]. In one district of Uganda, 30% of 5,109 women attending a clinic had received threats or physical abuse. The majority of respondents viewed wife beating as justifiable in some circumstances[6]. In Durban, South Africa, more than one third of women from a low-income community had experienced domestic violence at some stage[7]. A South African study reported domestic violence associated with violence in childhood, education and multiple partners[8, 9]. In southern Africa domestic violence is particularly important because of the multiple links between violence and HIV infection[10]. Links between domestic violence and HIV have been reported in Botswana[11], Ghana[12], Malawi[13], South Africa[14], Tanzania[15], Uganda[16, 17], Democratic Republic of Congo[18] and Zambia[19].

This is a baseline assessment of attitudes and practices, from which we intend to measure the impact of mass media campaigns, launched since the baseline by Soul City. The survey content was thus geared to measure the impact of education-entertainment messages[20], rather than as a specific research hypothesis. One section of the questionnaire dealt with domestic violence – attitudes and subjective norms, collective efficacy, discussion of the issue and experience of physical domestic violence in the last year – and the results are reported here as a cross-sectional survey.

Methods

Design

In Botswana, Lesotho, Swaziland, Malawi, Mozambique, Namibia, Zambia and Zimbabwe we stratified the most recent available census into rural, urban (not within the capital region), and urban capital sites. In each country, we drew a last stage random selection of enumeration areas, with probability proportional to the national population (Table 1).

Table 1

Sample weights in each country

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

Sample population

13689

16812

34488

9030

9898

14512

16189

12346

126964

% rural (sample population)

45%

83%

85.1%

51.6%

58.3%

74.5%

65.6%

63.6%

70.2%

Rural weight (Actual pop/sample pop)

1.016

0.971

1.005

1.316

1.032

1.033

1.046

1.047

1.007

% urban (sample population)

47%

4.7%

3.8%

37.2%

26.6%

18.5%

21.4%

17.3%

18.0%

Urban weight (Actual pop/sample pop)

0.923

2.034

1.304

0.693

0.892

0.909

0.835

1.003

1.019

% capital (sample population)

8.1%

12.2%

11.1%

11.2%

15.1%

7%

13.1%

19.2%

11.8%

Capital weight (Actual pop/sample pop)

1.356

0.799

0.855

0.564

1.067

0.890

1.039

0.840

0.927

% country (sample population)

10.8%

13.2%

27.2%

7.1%

7.8%

11.4%

12.8%

9.7%

100%

Country weight(Actual pop/sample pop)

0.298

0.254

0.708

4.160

0.407

0.158

1.343

2.315

1.000

Training and fieldwork

After training, coordinators translated, back-translated and piloted the common instruments in 29 languages: Afrikaans, Bemba, Changana, Chichewa, Chindali, Chitimbuka, Chona/Shona, Chope, English, Herero, Kalanga, Kaonde, Kwangali, Lozi, Luvale, Mucua, Ndau, Ndebele, Nyanja, Oshiwambo, Portuguese, Ronga, Sena, Sesotho, Seswati, Setswana, Shangaan, Xitshwa and Xitsonga. Each field team of seven or eight interviewers visited approximately 10 communities, one per day. Interviewers tried to cover all households in each enumeration area, without sub-sampling. In each household, they interviewed all adults aged 16–60 years present at the time of the visit.

Ethical considerations

An accredited international ethical review board evaluated the proposal, noting concerns that disclosure might place the respondent at risk and that the questions about sexuality probed confidential issues. Interviewers informed each respondent of their right to refuse to participate, and of their right to refuse to answer any question. Before starting the questionnaire, the interviewers requested verbal consent to proceed. They did not record names or other identifying feature, and took precautions that the interview was out of hearing of others.

Outcome measures

We defined domestic physical violence by responses to the question: "In the last year, have you and your partner had violent arguments where your partner beat, kicked or slapped you?" To facilitate disclosure, interviewers asked this with the respondent alone. If this was not possible, they noted presence of a listener. Interviewers read questions without additional explanations, and recorded answers verbatim. Wherever possible, female researchers interviewed women and male researchers interviewed men. With the exception of one question about pregnancy, interviewers administered the same instrument to men and women.

We limited domestic violence to reports of physical abuse, and we had no measure of severity of the violence. We included items on attitudes to and subjective norms of domestic violence, collective efficacy to reduce domestic violence (Can your community do anything about violence against women?) and discussion of domestic violence (In the last year, how often did you talk with anyone about domestic violence? To whom did you speak most often about domestic violence?). In designing the evaluation of the impact of mass media, we anticipated that some effect might be measured in these intermediate outcomes before changing the actual occurrence of domestic physical violence.

The relevance of partner physical violence to HIV/AIDS risk came from answers to the questions "Do you think you are at risk of getting HIV?" and "If you found you were HIV positive, how would you change your sex life", considering "always use a condom" and "abstain from sex" as positive values. Negative values included "no change", "spread it intentionally", "same partner" and "sleep with virgin to cure".

Analysis

Data technicians manually digitised questionnaire data twice and eliminated keystroke errors by verifying discordant entries with the original questionnaires. We weighted final estimates in line with the national populations and the eight-country estimates weighted national indicators by the population of each country (Table 1). In a univariate analysis, we stratified each association between partner physical violence and potential risk factors by each of the others in turn (List 1, see Appendix), initially ignoring multiple influences[21, 22]. We adjusted for the multiple comparisons by requiring 99% confidence.

For risk factors not explained by any stratifying variable and those with multiple influences, a step down logistic regression model tested the effect of country, age, sex, education, income, food security, household size, occupation, and the factors in List 1 (see Appendix). The several items on attitudes to sexuality and violence showed co-linearity, with no single variable attaining statistical significance in the preliminary logistic regression model. We included the variable from each group that showed the strongest association with the outcome in the model.

Results

Some 16% of men (weighted value based on 1,294/8,113) and 18% of women (weighted value based on 2,032/11,063) reported partner physical violence in the last year; 6.8% (809/11,872) of female respondents and 6.0% (521/8,634) of males declined to answer this question. The lowest rates of partner physical violence came from Mozambique (9%) and Malawi (9%) and the highest from Zambia (32%) (Tables 3 and 4). The 7.1% with someone else present at the time of the interview were more likely to report a violent altercation (OR 1.18, 95%CI 1.02–1.35; 285/1,459 compared with 2,974/17,381 alone at the time).

Table 3

MALE Experience of physical violence in the last year (beat, kicked or slapped), discussion about gender violence and participation in community action about violence against women

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

% (number) who had, in the last year, had violent arguments where a partner beat, kicked or slapped the respondent, of those who answered

Crude

189/929

91/768

72/1109

70/930

168/1113

162/1261

337/1261

205/1231

1294/8113

Weighted

21%

12%

6%

8%

15%

21%

27%

17%

16%

Missing

65

92

61

45

54

63

88

53

521

% who said they had not spoken with anyone about gender violence in the last year

Crude

638/960

489/825

748/1167

657/964

679/1152

515/798

803/1329

590/1271

5119/8466

Weighted

66%

57%

64%

69%

59%

65%

60%

46%

60%

Missing

34

35

3

11

15

37

20

13

168

% who had participated in community activities in the last year

Crude

71/930

47/785

44/1159

64/964

64/1142

29/772

48/1328

118/1242

485/8322

Weighted

8%

6%

4%

6%

6%

4%

4%

9%

6%

Missing

64

75

11

11

25

63

21

42

312

% (number) who consider violence against women a serious problem in their community

Crude

758/928

796/1152

796/1152

613/952

791/1134

505/773

722/1298

580/1220

5242/8257

Weighted

82%

60%

69%

64%

70%

65%

56%

47%

64%

Missing

66

60

18

23

33

62

51

64

377

% (number) who said their community CAN do anything about violence against women

Crude

692/899

479/767

663/1150

508/903

626/1108

434/732

545/1255

582/1014

4529/7828

Weighted

77%

64%

58%

56%

56%

59%

43%

57%

58%

Missing

95

93

20

72

59

103

94

270

806

Table 4

FEMALE Experience of physical violence in the last year (beat, kicked or slapped), discussion about gender violence and participation in community action about violence against women

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

% (number) who had, in the last year, had violent arguments where a partner beat, kicked or slapped the respondent, of those who answered

Crude

257/1371

207/1309

176/1586

148/1374

233/1382

221/1034

538/1509

252/1498

2032/11063

Weighted

19%

16%

11%

11%

17%

21%

36%

17%

19%

Missing

124

179

97

97

83

88

96

45

809

% who said they had not spoken with anyone about gender violence in the last year

Crude

1011/1424

741/1433

1203/1671

1009/1458

795/1452

648/1076

948/1586

722/1523

7077/11623

Weighted

71%

52%

72%

70%

55%

60%

60%

48%

61%

Missing

71

55

12

13

13

46

19

20

249

% who had participated in community activities in the last year

Crude

99/1401

53/1388

29/1659

76/1451

67/1425

29/1051

41/1576

142/1507

536/11458

Weighted

7%

4%

2%

5%

5%

3%

3%

9%

5%

Missing

94

100

24

20

40

71

29

36

414

% (number) who consider violence against women a serious problem in their community

Crude

1110/1364

856/1393

1164/1659

872/1421

1034/1420

699/1027

934/1523

777/1451

7446/11257

Weighted

81%

62%

70%

59%

73%

68%

61%

53%

66%

Missing

131

95

24

51

45

95

82

92

615

% (number) who said their community CAN do anything about violence against women

Crude

1002/1339

479/767

663/1150

508/903

626/1108

434/732

545/1255

582/1014

4529/7828

Weighted

75%

63%

45%

50%

58%

55%

45%

52%

55%

Missing

156

172

34

123

59

182

136

325

1187

Personal and household factors

Sex

The gender gap in reported domestic physical was negligible in Botswana, Lesotho, Namibia, Swaziland and Zimbabwe. Elsewhere, female respondents reported being the subjects of partner physical violence more frequently than did male respondents: in Malawi, the population weighted rates were 7% and 11% for males and females respectively (based on 72/1,109 and 176/1,586); in Mozambique, 7% and 11% respectively (based on 70/930 and 148/1,374) and in Zambia, 27% and 36% (based on 337/1,261 and 538/1,509).

Age

Respondents aged 30–39 years reported violent altercations more commonly (20.4% unweighted, based on 908/4,478), with lower rates among older and younger respondents (16–19 years 11.4% 365/3,211; 20–29 years 19.3% 1,518/7,931; 40–49 years, 17.3% 376/2,196; 50–59 years 12.1% 135/1,118; and 60–66 years, 11.0% 26/235).

Home language

We found high reported rates of domestic physical violence in four of 29 interview languages. No less than 54% (82/152) of Lozi speakers (Zambia) reported partner physical violence in the last year. From the same country, 46% (99/197) of Tonga, 34% (339/995) of Bemba and 28% (206/744) Nyanja responders reported partner physical violence.

Education

Some 31% (6,248/19,895) of the respondents had completed primary school; 3.5% (744/20,639) declined to answer this question. At first glance, the average person who had not completed primary school seemed more likely to report partner physical violence: OR 1.18 99%CI 1.05–1.32 (2,350/12,016 among those who had not completed primary education compared with 931/5,933 who had done so reported a violent altercation with a partner). This effect disappears entirely when stratifying by country; the levels of education combined with quite different rates of violent altercation seem to confound the measurement. In Zambia, the only country where education was associated with violent altercations, the average person who had not completed primary school was less likely to report a violent argument with a partner: argument with a partner: OR 0.82 95%CI 0.69–0.98 (600/1,979) among those who had not completed primary education compared with 266/768 who had done so reported a violent altercation with a partner).

Household size

We could find no obvious trend of violent altercation with increasing household size; missing data 6.6% (1,360/20,639). The average person living in a household with more than five members was less likely to report a violent altercation than one living in a household of 1–5 people (OR 0.88 99%CI 0.63–0.98; 1,295/7,887 in higher occupancy households compared with 2,049/11,383 in lower occupancy households reported a violent altercation).

Urban/rural residence

Most respondents lived in rural areas (63.1% or 13,017/20,639); a further 22.1% were urban (4,563/20,639) and 14.8% lived in the capital city (3,059/20,639). There was very little difference in partner physical violence: rural 17.8% (2,164/12,160), urban 17.2% (736/4,287) and capital 15.8% (447/2,837).

Total household income

One in every ten (1,940/18,370) reported no income in the last month (11% or 2,269/22,630 declined to answer this question). Stratifying by country, there was no convincing association of domestic physical violence with income (OR adjusted 1.08, 99%CI 0.85–1.53; 346/1,757 of those with no income and 27,017/15,458 of those with an income). There was no detectable gender difference in this effect.

Remunerated occupation

One in every ten did not register an occupation (3.7% 751/20,639 missing data). Housewives were most likely to report partner physical violence (25.6% based on 443/1,730), followed by those who described themselves as unemployed (19.5% based on 812/4,169). There was also no convincing association between remunerated occupation and partner physical violence (OR 0.95, 99%CI 0.8–1.1). We constructed a new variable to reflect the "income gap" between personal employment and total household income: overall, unemployed individuals in households with some income were more likely to report domestic physical violence (OR 1.43 99%CI 1.27–1.60; 901/4,111 with the income gap and 2,091/12,722 without it reported physical violence). On stratification by sex of respondent and country, however, it turned out that this association is ascribed mostly to women in Namibia and Zambia.

Food security

One in every three respondents reported having insufficient food in the last week (34.5% unweighted, 7,070/20,475); 0.8% (164/20,639) declined to respond. As with personal income, the average person reporting insufficient food was slightly more likely to report partner physical violence (OR 1.22 99%CI 1.10–1.35; 1,271/2,679 with insufficient food reported, compared with 2,052/12,536 with sufficient food). We could not explain this effect by urban/rural residence, country, attitudes to sexuality or sexual violence or any the personal factors we documented.

Attitudes about sexuality and sexual violence

Tables 5, 6, 7, 8, 9, 10 show the variation from country to country in attitudes about sexuality and sexual violence. Several of these beliefs were associated with partner physical violence (Tables 11 and 12): the belief that men have the right to have sex with girlfriends if they buy them presents (OR 1.42 99%CI 1.25–1.60), it is okay for an older man to have sex with teenagers (OR1.38 99%CI 1.20–1.59), women do not have the right to refuse sex with husbands and boyfriends (OR1.18 99%CI 1.05–1.30) and a person has to have sex to show love (OR 1.44 99%CI 1.38–1.59). Beliefs about gender violence were also associated with violent altercations: forcing one's partner to have sex is not rape (OR 1.23 99%CI 1.10–1.37) and women sometimes deserve to be beaten (OR1.56 99%CI 1.4–1.72). These associations were not explained by country, education, sex, remunerated occupation, income, multiple partners, household factors (like crowding, language, food security), or other attitudes and beliefs about sexuality or sexual violence.

Table 5

Male attitudes about sex

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

% (number) who said women do not have the right to refuse to have sex with their husbands or boyfriends.

Crude

383/981

393/829

568/1165

538/970

436/1151

369/824

681/1255

614/1258

3982/8433

Weighted

39%

47%

49%

55%

38%

45%

54%

49%

47%

Missing

13

31

5

5

16

11

94

26

201

% (number) who said a person has to have sex with their boyfriend or girlfriend to show that they love them

Crude

350/983

528/838

505/1166

523/971

446/1152

407/821

596/1336

318/1277

3673/8544

Weighted

36%

62%

44%

57%

39%

50%

45%

25%

44%

Missing

11

22

4

5

15

14

13

7

90

% (number) who said it is okay for an older man to have sex with teenagers.

Crude

75/985

162/820

62/1168

196/972

111/1158

84/826

129/1343

105/1280

924/8552

Weighted

8%

21%

5%

21%

10%

10%

10%

8%

11%

Missing

9

40

2

3

9

9

6

4

82

% (number) who said men have the right to have sex with their girlfriends if they buy them gifts

Crude

172/980

331/822

285/1166

491/969

365/1154

189/827

509/1342

266/1280

2608/8540

Weighted

18%

39%

25%

53%

32%

23%

38%

21%

31%

Missing

14

38

4

6

13

8

7

4

94

Table 6

Female attitudes about sex

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

% (number) who said women do not have the right to refuse to have sex with their husbands or boyfriends.

Crude

480/1466

594/1447

812/1679

772/1458

448/1457

429/1099

856/1516

662/1513

5053/11635

Weighted

32%

40%

49%

52%

31%

39%

57%

44%

43%

Missing

29

41

4

13

8

23

89

30

237

% (number) who said a person has to have sex with their boyfriend or girlfriend to show that they love them

Crude

428/1464

843/1452

763/1671

743/1461

411/1458

449/1104

651/1590

266/1533

4554/11733

Weighted

29%

58%

46%

54%

28%

41%

42%

17%

39%

Missing

31

36

12

10

7

18

15

10

139

% (number) who said it is okay for an older man to have sex with teenagers.

Crude

79/1470

226/1433

104/1679

289/1461

97/1459

108/1112

126/1596

134/1539

1163/11749

Weighted

5%

16%

6%

20%

7%

10%

8%

9%

10%

Missing

25

55

4

10

6

10

9

4

123

% (number) who said men have the right to have sex with their girlfriends if they buy them gifts

Crude

236/1468

534/1426

467/1671

651/1462

286/1450

186/1105

513/1593

216/1531

3089/11706

Weighted

16%

37%

28%

48%

20%

17%

33%

14%

27%

Missing

27

62

12

9

15

17

12

12

166

Table 7

Male attitudes about violence

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

% (number) who said women sometimes deserve to be beaten

Crude

357/978

345/818

348/1166

395/968

505/1159

415/822

715/1337

421/1278

3501/8526

Weighted

37%

41%

30%

41%

44%

51%

53%

33%

41%

Missing

16

42

4

7

8

13

12

6

108

% (number) who said if a woman gets raped its her own fault

Crude

165/981

260/823

508/1162

452/970

209/1155

161/816

268/1337

178/1272

2201/8516

Weighted

17%

31%

44%

49%

18%

20%

20%

14%

26%

Missing

13

37

8

5

12

19

12

12

118

% (number) who said forcing sex with someone you know is not rape

Crude

242/982

302/824

299/1165

240/971

254/1158

84/821

346/1338

205/1281

1972/8540

Weighted

25%

36%

26%

25%

22%

10%

26%

16%

23%

Missing

12

36

5

4

9

14

11

3

94

% (number) who said Forcing your partner to have sex, is NOT rape

Crude

198/982

292/829

455/1166

309/971

401/1157

261/821

618/1340

395/1276

2929/8542

Weighted

20%

35%

39%

33%

35%

32%

46%

31%

34%

Missing

12

31

4

4

10

14

9

8

92

% (number) who said violence between a man and a woman is a private matter in which others shouldn't interfere

Crude

296/977

522/823

875/1165

546/970

497/1152

430/820

754/1335

628/1272

4548/8514

Weighted

30%

63%

75%

58%

43%

53%

57%

50%

54%

Missing

17

37

5

5

15

15

14

12

120

Table 8

Male attitudes about violence

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

% (number) who said women sometimes deserve to be beaten

Crude

279/1459

426/1429

654/1677

539/1463

425/1454

436/1099

751/1592

368/1536

3878/11709

Weighted

19%

30%

39%

38%

29%

40%

47%

24%

33%

Missing

36

59

6

8

11

23

13

7

163

% (number) who said if a woman gets raped its her own fault

Crude

158/1463

339/1427

625/1673

544/1462

143/1458

120/1104

306/1591

171/1538

2406/11716

Weighted

11%

24%

37%

39%

10%

11%

19%

11%

21%

Missing

32

61

10

9

7

18

14

5

156

% (number) who said forcing sex with someone you know is not rape

Crude

324/1466

506/1428

437/1674

436/1462

259/1459

146/1108

448/1593

261/1535

2817/11725

Weighted

22%

36%

26%

29%

18%

13%

28%

17%

24%

Missing

29

60

9

9

6

14

12

8

147

% (number) who said Forcing your partner to have sex, is NOT rape

Crude

279/1467

509/1458

754/1676

536/1464

476/1457

371/1110

807/1592

515/1529

4247/11753

Weighted

19%

35%

45%

36%

33%

34%

51%

34%

36%

Missing

28

30

7

7

8

12

13

14

119

% (number) who said violence between a man and a woman is a private matter in which others shouldn't interfere

Crude

360/1458

809/1428

1335/1678

813/1461

556/1457

517/1102

831/1591

790/1523

6011/11698

Weighted

24%

57%

80%

56%

38%

47%

52%

52%

51%

Missing

37

60

5

10

8

20

14

20

174

Table 9

Male attitudes and subjective norms about sexual violence

% (number) who said

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

In my culture it is acceptable for a man to beat his wife

Crude

268/983

337/812

151/1163

317/965

327/1158

203/813

507/1329

382/1275

2492/8498

Weighted

27%

41%

13%

33%

28%

25%

38%

30%

29%

Missing

11

48

7

10

9

22

20

9

136

most people in our community feel women have a right to refuse sex with their partners

Crude

473/899

386/766

574/1142

461/957

741/1133

338/766

601/1251

505/1186

4079/8100

Weighted

53%

52%

50%

49%

66%

44%

48%

43%

50%

Missing

95

94

28

18

34

69

98

98

534

most people in our community feel forcing your partner to have sex is rape

Crude

650/943

509/777

616/1150

582/956

760/1138

491/801

602/1266

757/1212

4967/8243

Weighted

69%

66%

54%

60%

67%

61%

47%

63%

60%

Missing

51

83

20

19

29

34

83

72

391

Table 10

Female attitudes and subjective norms about sexual violence

% (number) who said

Botswana

Lesotho

Malawi

Mozambique

Namibia

Swaziland

Zambia

Zimbabwe

TOTAL

In my culture it is acceptable for a man to beat his wife

Crude

307/1449

495/1418

250/1674

441/1463

310/1451

183/1093

531/1587

425/1528

2942/11663

Weighted

21%

35%

15%

32%

21%

17%

34%

28%

25%

Missing

46

70

9

8

14

29

18

15

209

most people in our community feel women have a right to refuse sex with their partners

Crude

683/1317

682/1302

721/1647

675/1421

933/1423

528/1041

685/1444

685/1381

5592/10976

Weighted

52%

54%

44%

49%

66%

50%

47%

50%

51%

Missing

178

186

36

50

42

81

161

162

896

most people in our community feel forcing your partner to have sex is rape

Multiple partners

One in every four respondents (4,468/17,948) who answered the question reported having two or more sexual partners in the last year; 15.9% (3,276/20,639) declined to answer. The proportion reporting multiple partners, out of those who had partners in the last year, varied somewhat by country: Botswana 32.1% (566/1,760), Lesotho 43.9% (780/1,760), Malawi 12.5% (274/2,195), Mozambique 31.6% (706/2,212), Namibia 21.0% (440/2,062), Swaziland 35.1% (517/1,465), Zambia 26.0% (600/2,316) and Zimbabwe 26.8% (585/2,175).

Using two or more partners in the last 12 months as a definition of multiple partners, there was a strong association with partner physical violence: female respondents OR 1.87 99%CI 1.46–2.41 (450/1564 of those with two or more partners compared with 1479/8332 among those with one on no partners) and male respondents OR 2.00 99%CI 1.47–2.66 (627/2755 among those with two or more partners compared with 592/4616 among those with one or no partners).

In all age groups in all countries, having multiple partners was a risk factor for violent altercations. A logistic model taking into account country, food security, sex of respondent, income, education and employment accentuated the risk of violent altercations for people with multiple partners (unadjusted OR 1.75, adjusted OR 2.03 99%CI 1.65–2.42, indicating underestimation of the unadjusted estimate).

Partner physical violence increased progressively with number of partners in the last 12 months: 234/1689 (13.9%) with no partners, 16.3% (1849/11324) with one partner, 22.7% (516/2269) with two partners, 25.4% (253/1034) with three partners, 29.2% (118/405) with four and 29.2% (185/633) with five or more partners reported domestic physical violence in the last year (χ2 199.8, 5 df).

Community dynamics and collective efficacy

A large proportion of the sample (65%, 12760/19626) said that domestic violence was considered a serious issue in their community (4.9% missing data, 1004/20639). Yet two thirds (9944/15880) of those who did not report physical violence and one half of those reporting partner physical violence in the last year (1654/3336) had never spoken about it. Those who spoke about it did so most frequently with friends (50.0% 3754/7504) and family (24.2%, 1819/7504). One in every ten said they had discussed with a neighbour (720/7504) and another one in ten with a partner or spouse (745/7504). There were no remarkable differences between male and female respondents, or between those who reported violent altercations and those who had not done so.

Over one half of the respondents said that their community could do something about violence against women (unweighted 56.2% based on 10466/18617, missing data 2017/20639 or 9.7%). Male respondents were more likely to express collective efficacy (OR 1.12 99%CI 1.02–1.23, 4529/7828 male and 5879/10685 female respondents felt their communities could do something about violence against women). Collective efficacy was highest in Botswana (75.6% 1715/2268) and Lesotho (62%, 1299/2095) and lowest in Zambia (44.5%, 1215/2732).

Relevance of partner physical violence to HIV risk

People who reported partner physical violence (male or female) were significantly more likely to believe they were at risk of getting HIV (OR 1.51, 99%CI 1.37–1.68; 1615/3075 who reported partner physical violence and 6261/14832 who did not report partner physical violence said they were at risk of HIV infection). This was not explained by country, sex of the respondent or any of the factors we could test in this study.

The average male respondent who reported partner physical violence was significantly more likely to anticipate a negative reaction to knowing he was HIV positive (no change, spread intentionally, sleep with virgin, etc) compared with one who had not suffered violence in the last year (OR 1.51, 99%CI 1.23–1.83, 286/1163 among those reporting and 1089/6142 not reporting partner physical violence). This association did not hold for female respondents, and among men it was not explained by country or any of the other variables we could test (List 1, see appendix).

Discussion

High rates of domestic physical violence in all eight countries were conspicuously independent of education, household size, household income and remunerated employment. After taking into account age, sex, country and other factors, domestic physical violence was strongly associated with income gradients (being unemployed in the context of some household income) and home language in one country, and with multiple partners in the last year in all countries. Victims of partner physical violence were more likely to feel at risk of HIV infection and more likely to anticipate antisocial behaviour if they found they were HIV positive.

This is a cross-sectional household survey based on face-to-face interviews. This design limits conclusions about causality of, for example, multiple partners leading to physical violence or being the consequence of physical violence. It is likely that some respondents held back from expressing their true belief or experience. Even with the best field practices – including independent translation and back-translation of questionnaires, standardised training of local interviewers, in-country piloting and consultation with local community representatives, double-data entry and verification – measurement error is possible. The sample makes the results relevant to the eight countries, but not necessarily to other countries.

A major limitation is that we only considered domestic physical violence. This almost certainly underestimates the level of domestic violence. Other forms (verbal, sexual, economic and psychological) were beyond the scope of the study. In all countries we asked the same questions of men and women. We were able to examine several intermediate outcomes related to domestic violence – including attitudes, subjective norms, collective efficacy and discussion/socialisation – but most of these could be addressed only superficially through one or two items in the questionnaire.

We had no measure of severity or frequency of physical domestic violence, making it difficult to interpret the proportion of men and women who reported partner violence in the last year. Large studies in the UK and USA have reported similar proportions of partner violence for males and females, but found male on female violence to be more severe than female on male violence[23, 24]. It is quite possible that the same is true for southern Africa. The men we interviewed were at home during working hours and, in this respect at least, they may not be typical of all men in the eight countries. We also did not ask who initiated the altercation, so it is also possible these reports reflect women defending themselves from male-initiated violence. Even so, the finding is compatible with a degree of female agency in domestic physical violence and supports our conclusions from South Africa that initiatives against sexual violence should look beyond gender stereotypes of victims and villains[25].

There was no recognisable pattern of poverty and domestic violence between countries (Mozambique, the poorest country, reported the lowest rates while Zambia reported the highest). We also did not find significant associations between victims and their individual education or employment, and we could only address the income gradient between partners through a proxy variable. It is possible that in-household inequality in education and income could be more relevant to domestic violence than we were able to measure in this study[26]. There was no interpretable association between the Gini coefficient (measuring inequality in the country) and male or female reports of violence (Tables 3 and 4). The Gini coefficient used for Botswana and Lesotho was 0.63, Malawi 0.50, Mozambique 0.40, Namibia 0.74, Swaziland 0.61, Zambia 0.42 and Zimbabwe 0.61[27].

The occurrence of domestic physical violence in some parts of Zambia raises the question of something being done differently there, despite efforts to reproduce exactly the same survey in all countries. Whatever the reason for the higher rates of domestic physical violence detected in Zambia, it seems unlikely the same error lies behind the inability to demonstrate an association between violent altercations and education, overcrowding, income and age – consistent across all the countries.

Conclusion

If there is good news from this study, it is that multiple partners, attitudes and subjective norms are more in the control of most individuals than are poverty, overcrowding and education – without detracting from the need for massive investment in these sectors.

An unanswered question is how to modify attitudes or multiple partners. There is also no guarantee that changing attitudes will, on its own, impact on behaviour. The study confirms the importance of moving beyond gender stereotypes of victims and villains. Men also report suffering partner physical violence, although our inability to measure severity could mask an important gender difference. The solutions to domestic violence lie with both men and women, and both have agency in this regard. There was also a prominent sense of collective efficacy, the majority expressing they could do something about domestic violence.

Although many thought their community could deal with violence against women, few victims and still fewer of the non-victims said they had discussed violence against women with anyone. Stimulating discussions about violence against women offers one direction for initiatives against partner physical violence. Wider discussion could influence social norms, in addition to targeting individual attitudes and supportive public policy.

Appendix

List 1. Variables tested sequentially, from which independent associations were included in logistic regression model

Individual and household characteristics

How many people live in the household

Age and sex of each one

Language spoken at home most of the time

Last grade of education respondent completed

Main occupation of respondent

Total household income per month

Did household have enough food in the last week

Was the respondent alone or was someone listening

HIV risk

Do you think you are at risk of getting HIV

If you found you were HIV positive, how would you change your sex life

Sexual violence

If a woman gets raped its her own fault.

Forcing sex with someone you know is not rape.

Forcing your partner to have sex is rape.

Subjective norms about sexual violence

Do most people in your community feel forcing your partner to have sex is rape?

Do most people in your community feel women have a right to refuse sex with their partners?

Is violence against women considered a serious problem in this community?

Collective efficacy about sexual violence

Can your community do anything about violence against women?

Attitudes to domestic violence

Women have the right to refuse to have sex with partner

Violence between a man and a woman is a private matter Women sometimes deserve to be beaten.

Subjective norms about domestic violence

Do most people in your community feel women sometimes deserve to be beaten?

Discussion about domestic violence

In the last year, how often did you talk with anyone about domestic violence? [never, seldom or often]

To whom did you speak most often?

Practices relating to domestic violence

What community activity about violence against women have you participated in?

In the last year, have you and your partner had violent arguments where someone was physically hurt?

Transactional sex

Men have the right to have sex with their girlfriends if they buy them gifts.

Its okay for an older man to have sex with teenagers

A person has to have sex with their boyfriend or girlfriend to show that they love them.

Do most of your friends feel men have the right to sex with their girlfriends if they buy them gifts?

Acknowledgements

The eight national surveys were funded by a grant from the European Union, made available through Soul City. Lorenzo Monasta trained fieldworkers and coordinated fieldwork in Malawi, as did Charlie Whitaker in Mozambique, Sharmila Mhatre in Zambia, Manuel Pascual Salcedo in Swaziland and Lesotho, and Serge Merhi in Namibia and Zimbabwe. Marietjie Myburg supported fieldwork in Swaziland and Lesotho. Candyce Hamel provided analysis support.

Competing interests

All authors declare that there is no competing interest. Esca Scheepers and Sue Goldstein were employed by Soul City, which subcontracted the national education-entertainment programmes in the eight countries.

Authors' contributions

NA was involved in study and questionnaire design, statistical analysis, drafting manuscript. AHF was involved in statistical analysis, interpretation and drafting manuscript. SM was involved in study design, acquisition of data, drafting manuscript. ES and SG were involved in study and questionnaire design, analysis and interpretation, drafting manuscript, administration and technical support. NA, AHF, ES and SG had full access to all data and take responsibility for the integrity of the data and accuracy of data analysis. All authors read and approved the final manuscript.

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